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BOOKS: ‘MORTALITY,’ by Christopher Hitchens

Autobiographical books on cancer mortality are generally not high on oncologists' reading lists. First and most importantly, because we see so many of these stories played out in real time. Second, while the books are cathartic for the writer and focus on particular issues of personal importance, regrettably it is only infrequently that they provide fresh perspectives, and they rarely bring the linguistic elegance of a professional writer.

However, once in a while, Cancer, that cruelly egalitarian illness, strikes someone with both great writing skills and a unique gift for capturing important insights with facility and flair.

Christopher Hitchens, the author of Mortality, has such a gift. The author of more than 20 books including several international best sellers and National Book Award finalists, he was a contributing editor to Vanity Fair, The Atlantic, Slate, and The Nation, among others. He was also, as Vanity Fair Editor Graydon Carter says, “a wit, charmer, and troublemaker with insatiable appetites for cigarettes, scotch, company, great writing, and conversation.” All these attributes are reflected in this short (104-page) book that packs a lot into a little. Don't be put off by the stark black book cover or by the title.

The book is full of insight, irony, compassion, and humor. Most of all it is free of sentiment and self-pity.

As Hitchens relates, in June 2010, the very day his book Hitch-22 hit the best seller list, he was struck with excruciating chest pain and felt “shackled to my own corpse.” Thus begins his story that takes him “from the country of the well across the stark frontier that marks off the land of malady.” This different world referred elsewhere in the book as “Tumorland” or its inhabitants as “citizens of the sick country” is captured superbly by Hitchens as a bizarre place of alienation and isolation.

He deftly tackles his personal experience with the Elizabeth Kübler-Ross stages of grief by admitting that denial played a minor role for him. As a heavy smoker and drinker, he candidly rejects the “Why me?” for “Why not me?” Rage he says is beside the point and certainly doesn't surface in his writing.

It is with the bargaining stage that we begin to see Hitchens' style emerge. He sees the Oncology Bargain as a wager. As he puts it, for a chance to stick around for a bit longer you need to give up some things in exchange—such as your ability to concentrate, to keep food down, and to have the hair on your head. This he feels is a reasonable trade.

Hitchens frequently uses amusing examples to develop more serious themes for the reader. For example, he contrasts an essay by Pauline Kael about Hollywood “as a place where you could die of encouragement” to Tumortown where “you sometimes feel that you may expire from sheer advice.”

He then relates a whole series of anecdotes about advice from well-meaning folks which propose cures, generate false hopes, and suggest life-saving protocols for which he is not eligible, drugs only available somewhere else, and miraculous treatments not relevant to his cancer.

While the style is entertaining, the underlying message is that the information deluge is confusing, rarely helpful, and often depressing, disruptive, and disheartening.

‘Cancer Etiquette’

This leads Hitchens to propose that what is needed is a short handbook on Cancer Etiquette. This would include advice for the sufferer as well as the sympathizers. Such a book, he says, would place duties on both the “populations of Tumortown and Wellville” and set ground rules for behavior. This reader only regrets that Hitchens never had the time to write such a book as many of the common mistakes in communication and behavior are deftly illustrated.

For example, the banality of phrases like “How are we feeling today?” or “any discomfort?” from well wishers or medical personnel contrasts starkly with the nausea, ulcers, sores, and endless needle sticks experienced by cancer patients. Hitchens captures what it feels like when describing his condition after proton therapy for his esophageal cancer: “I lay for days on end, trying in vain to postpone the moment when I would have to swallow. Every time I did swallow, a hellish tide of pain would flow up in my throat, culminating in what felt like a mule kick in the small of my back.” “Any discomfort” indeed!

Cancer patients become highly sensitized to the nuances and bitter ironies of common language in ways not recognized by those of us both lay and medical who are not ill.

Hitchens is witty and irreverent about the medical establishment. He quotes Stanford Professor Sidney Hook, who when seriously ill wrote that “based as he was in the medical mecca of Stanford, he was able to avail himself of a historically unprecedented level of care, while at the same time being exposed to a degree of suffering that previous generations might not have been able to afford.”

At the same time, Hitchens often uses humor, irony, and artistry to delve into some of the most difficult problems cancer patients endure. He explores the communications barriers; the plethora of complications both of the cancer and its treatment; and the ultimate challenge of coming to grips with the reality of mortality.

In the lovely afterword written by his wife, Carol Blue, she describes a man who insisted ferociously on living, who responded to every bit of good news with hope and enthusiasm, but who was well aware of the reality of the “land of malady” he had entered 19 months earlier.

This is a strong, informative account seen through the eyes of a very skilled and facile writer. It leaves the reader with some provocative thoughts about communication gaps and the limitations of the care provided for cancer patients. Hearing this message presented so artfully may make us more perceptive oncologists.

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